Article excerpt

Introduction

Cardiovascular diseases (CVDs) are the leading cause of death in the United Kingdom, where coronary heart disease (CHD) and stroke cause 150 000 deaths every year. Of these CVD deaths, more than 40 000 occur prematurely, in people younger than 75 years. (1) Apart from smoking, the main risk factors for CVD are elevated blood cholesterol, elevated blood pressure, obesity and diabetes, all related to poor eating habits. According to the United Kingdom's government report for 2008, poor nutrition causes more than 70 000 preventable premature deaths annually, mainly from CVD. (2) A recent paper estimated this figure at 33 000 deaths. (3) Regardless, the health effects of poor nutrition pose an enormous economic burden; poor diet alone costs the government of the United Kingdom an annual 6 billion pounds sterling. (3)

CVD is consistently associated with the so-called "Western" diet, consisting mainly of dairy products, meat and processed foods. (2-5) CVD mortality rates are twice as high among segments of society that follow such a diet than among people who eat sensibly. (2-4) Salt, sugar, saturated fat and trans fats are harmful when consumed in excess; conversely, fruit and vegetables (which contain potassium, antioxidants and fibre), polyunsaturated fats (e.g. from sunflower and canola oil), mono-unsaturated fats (e.g. from olive oil), whole grains, pulses, nuts and fish have consistently shown a protective effect against CVD. (2-4)

In the United Kingdom and the United States of America, processed foods and fast, takeaway foods are the main dietary sources of excess salt, saturated fats, trans fats and excess calories. In 2001 the Food Standards Agency (FSA) of the United Kingdom began working with industry to develop a range of healthy food strategies, (5) including voluntary product reformulation, clearer (traffic light) package labelling of nutrient levels and media campaigns. The FSA's salt strategy helped reduce the average daily salt intake by nearly 1 g between 2001 and 2008 (from 9.5 to 8.6 g, respectively). (6) However, outside the United Kingdom stricter regulatory policies have resulted in much greater reductions. (7) For instance, between 1979 and 2002 Finland's daily average salt intake fell from 12 g to 9 g. (7)

The FSA's strategy in the United Kingdom also sought to reduce the daily average intake of saturated fat from 13.3% to 11% of total food energy by 2010, (5) yet currently the figure stands at 12.8%. (6) Finland and Iceland, on the other hand, reduced saturated fat intake by 5% of total energy in one or two decades. (4,8) Furthermore, in the traditional Italian and Japanese diets and the successful DASH and OMNI diets, 6% of total energy comes from saturated fats. (9)

Dietary industrial trans fats, resulting from the partial hydrogenation of vegetable oils, are particularly toxic. By raising serum low-density lipoprotein (LDL or "bad" cholesterol) and reducing high-density lipoprotein (HDL or "good" cholesterol), they substantially increase the risk of CHD and stroke. (10) The Government of the United Kingdom currently recommends consuming less than 2% of total energy in the form of trans fats. Average trans fat intake for adults in the United Kingdom reportedly represents only 0.8% of total energy consumption. (6,11) However, the true value is probably closer to 1% because routine surveys tend to underestimate consumption outside the home, particularly from fast foods. Furthermore, ethnic minorities, low-income adults and children probably consume substantially more. (12) In contrast, Denmark's 2004 legislative ban eliminated the consumption of dietary industrial trans fats within a year (from a baseline of 4%). (13) Currently Austria, Canada, Iceland, Switzerland and several states in the United States are aggressively working to eliminate trans fats. (10)

Finally, the average quantity of fruit and vegetables eaten daily in the United Kingdom has levelled at about 245 g since 2003. …